pharmacology: diuretics Flashcards
what are the categories of diuretics?
osmotic diuretics, carbonic anhydrase inhibitors, loop diuretics, thiazides, K+ sparing agents
what are the osmotic diuretics?
mannitol (IV) - inhibits water reabsorption throughout the tubule which increases urine volume
mannitol uses and side effects
uses: decreases IOP in glaucoma decreases intracerebral pressure oliguric states (rhabdo)
SE: acute hypovolemia
what are the carbonic anhydrase inhibitors? mechanism?
acetazolamide and dorzolamide mechanism: carbonic anhydrase inhibition resulting in: decreased H formation inside PCT cell decreased Na/H antiport increased NA and HCO3 in lumen increased diuresis
carbonic anhydrase inhibitors uses
glaucome, acute mountain sickness, metabolic alkalosis (loss of bicarb)
carbonic anhydrase inhibitors side effects
bicarbonaturia and acidosis with hypokalemia****** hyperchloremia paresthesias renal stones sulfonamide hypersensitivity
what are the loop diuretics? mechanism?
ethacrynic acid and furosemide mechanism: Na/K/2Cl transporter inhibition resulting in: decreased intracullular K in TAL decreased back diffusion of K decreased positive potential decreased reabsorption of Ca and Mg increased diuresis
ethacrynic acid and furosemide uses
acute pulmonary edema, heart failure, hypertension, refractory edemas, acute renal failure, anion overdose, hypercalcemic states
ethacrynic acid and furosemide side effects
sulfonamide hypersensitivity (furosemide) hypokalemia and alkalosis hypocalcemia hypomagnesemia hyperuricemia ototoxicity
ethacrynic acid and furosemide drug interactions
aminoglycosides (enhanced ototoxicity)
lithium (chronic loop administration, decreased clearance)
digoxin (increased toxicity due to electrolyte disturbances)
what are the thiazides? mechanism?
hydrochlorothiazide and indapamide
mechanism: Na/Cl transporter inhibition resulting in:
increased luminal Na and Cl in DCT
increased diuresis
thiazides (hydrochlorothiazide and indapamide) uses
HTN, CHF
nephrolithiasis (calcium stones)
nephrogenic diabetes insipidus
thiazides (hydrocholorthiazide and indapamide side effects
sulfonamide hypersensitivity hypokalemia and alkalosis hypercalcemia hyperuricemia hyperglycemia hyperlipidemia
hydrochlorothiazide and indapamide drug interactions
digoxin
avoid in DM
what are the K sparing agents
spironolacton, amiloride, triamterene
spironolactone mechanism and uses
mechanism: aldosterone-receptor antagonist
uses: hyperaldosteronic state
adjunct to K wasting diuretics
antiandrogenic uses (female hirsutism)
CHF
spironolactone side effects
hyperkalemia and acidosis
antiandrogen (eplerenone selective)
amiloride and triamterene mechanism, use, side effects
mechanism: Na channel blockers
use: adjunct to K wasting diuretics, lithium induced nephrogenic diabetes insipidus
side effects: hyperkalemia and acidosis
which diuretics cause blood acidosis?
acetazolamide (secretion of HCO3), amiloride, tramterene, spironolactone, eplerenone
which diuretics cause blood alkalosis
ethacrynic acid, furosemide, hydrochlorothiazide, indapamide
